Provider Demographics
NPI:1518005081
Name:RAYNES, JEANNE JACKSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:JACKSON
Last Name:RAYNES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:300 E STATE ST STE 690
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5235
Mailing Address - Country:US
Mailing Address - Phone:909-908-4638
Mailing Address - Fax:
Practice Address - Street 1:3075 MYERS ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5525
Practice Address - Country:US
Practice Address - Phone:951-358-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical